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As you probably know, type 2 diabetes has become a major health problem in the US and around the world. People with type 2 diabetes cannot effectively use glucose (sugar) from the food they eat to fuel the body. As a result, blood sugar levels are consistently higher than normal. Over time this can lead to serious, even deadly, complications such as heart disease, kidney disease, and stroke. The slow and insidious nature of persistently high blood sugar can also cause problems that interfere with quality of life, including vision changes, nerve pain and infections that are slow to heal.

It is estimated that 415 million adults around the globe have diabetes, and by the year 2040 this number will increase to 642 million! It’s a tremendous problem, in both the number of people affected and the health consequences of untreated diabetes. Of the 30.3 million adults in the US with diabetes, 23.1 million were diagnosed and 7.2 million were undiagnosed! An even greater cause for concern is the many people who have higher than normal blood sugar (prediabetes) and are on the verge of developing type 2 diabetes. It is estimated that in 2015, 84.1 million Americans age 18 and older had prediabetes.

Some populations are especially vulnerable to diabetes and its complications

As daunting as all that sounds, the situation is even worse for some racial and ethnic minorities in the US. Latinos/Hispanics, African Americans, American Indians, Native Hawaiians, Pacific Islanders, Arab Americans, and Asian Americans have a higher risk for diabetes and its deadly complications.

Why? There are genetic factors that affect the ability of the pancreas to produce enough insulin and/or the ability of the body to respond to insulin. In addition, some of these populations have a genetic tendency to accumulate fat in the belly (abdominal obesity). This can have metabolic consequences that increase the risk for diabetes, heart disease and other health problems. In addition, lifestyle factors such as inappropriate nutrition and lack of physical activity lead to increasing rates of obesity, a major risk factor for type 2 diabetes. And there are other non-medical issues that contribute to this problem. Disparities in income, education, health literacy, and access to health care may result in otherwise preventable (or treatable) cases of diabetes. And for some, cultural factors are barriers to preventing diabetes and controlling the disease appropriately.

So what to do?

If we stopped this story right here, you might get the impression that these populations are fully responsible for the health problems they are facing, and that there is nothing we can really do about it. But that is simply not the entire story. We can, and should, look at the clear inequalities in health care delivery that may influence the development and progression of some chronic diseases such as diabetes. In 1999, Congress asked the Institute of Medicine to assess these disparities. The goal was to explore factors that may contribute to inequities in care and devise strategies to mitigate these disparities.

The report from that study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that medical care varied greatly by race, even when insurance status, income, age, and severity of conditions are comparable. This research indicates that US racial and ethnic minorities are less likely to receive even routine medical procedures. They are also more likely to experience a lower quality of health services around diabetes and other conditions.

One of the first steps in addressing these issues is to make the general public, health care providers, insurance companies, and policy makers aware of these disparities and the public health consequences of them. It is especially important for health care providers across the nation to be aware of the multiple biological, social, psychological, financial, and cultural factors that influence diabetes and other diseases, and to routinely take these into consideration when developing prevention and treatment programs for all groups.

We’ve come a long way in the fight against diabetes. However, as we continue with our collective work to improve the lives of people with diabetes and those at risk for the disease, we should not forget there are some people who need an extra hand. That is simply the right thing to do.

Dr. Caballero was recently recognized by the City of Boston for his unwavering commitment and continuous work to improving the health of Latinos in the community.

Comments:

Accepting and continuously highlighting the fact that racism is embedded in many components of American society, including healthcare, is essential to mitigating these cyclic health outcomes. Multiple chronic diseases (hypertension,diabetes, heart disease, etc) are more common in ethnic minorities such as African Americans and Hispanics/Latinos. While genetic factors play a role, behaviors and environment factors, as well as quality of care, play a role as well. Environments that limit the ability to carry out healthy behaviors such as outdoor physical activity due to lack of green space, facilities, safety, and cleanliness already put an individual at a disadvantage. Additionally, these neighborhoods may also have an abundance of fast food restaurants and corner stores, but a lack of grocery stores with affordable fresh produce. These features are common in low-income communities which have been shown to be mainly populated by minorities. This, in combination with the issue mentioned in regards to quality of care for minorities only exacerbate the issue.

Efforts must be taken in improving the infrastructure of these communities and in improving the attitudes of healthcare providers and health policy makers. While infrastructure and the creation of health promoting establishments may be long term projects, individuals taking the time to address their own implicit bias or overt racism can yield instant improvements. There must be consistent coverage of the pervasiveness of racism in American society and how it impacts the quality of life of minorities. This in turn, threatens the public health outcomes of the U.S as a whole. By ignoring these truths or being willfully ignorant to them, we are encouraging the idea that it simply does not exist. Unfortunately, that mindset will not help the problem. It is time to become relentlessly aware.

My husband has had many heart surgeries and a stroke in 2003, which left him visually impaired. He had 4 stents and a defibulator, and now need a new battery and it made into a Pacemaker within the early part of 2018. when the cardiologist at Scripps thinks he is ready. He also has Water on the Lung, which the urologist does not want to operate on since it is too dangerous, and an enlarged prostate. He was pre-diabetes for years until criteria changed and he was diagnosed with Diabetes 2. He exercises and watches his diet. He is 79 years old and now cannot walk nearly as much as he used to do in the walking club, and only can walk for 2 blocks without having to stop and find a bench. He recently was diagnosed with Brittle Diabetes, and his numbers were a high of 523 to the usual very low numbers of 56 to 75, most days by late afternoon, or even before lunch. After speaking with the Diabetes Educator at Scripps Anderson Pavilion, in S.D. she told me to give him more snacks, every 2 hours of a protein and sweets. He sweats profusely on the forehead and scalp when the numbers are so low. WE have gone out to diner two nights in a row, and he had unsalted peanuts and fruit before leaving the house. In just over an hour of getting to the restaurant, he started sweating profusely. He had candy on him, and I gave him some sweet coleslaw and red peppers from my platter, which slowed it down a little. Then I got my free Birthday treat, one night a chocolate mouse and the next night mud pie, with whipped cream, and chocolate base, drizzled in chocolate syrup. We shared some and brought the rest home and put in our freezer. This morning, after all that sugar, and a tangerine and sliced almonds before he went to sleep, his number was 120, a great number. Yesterday morning, after the chocolate moose, with whipped cream and strawberry slices, and later melon slices and hot tea, and then unsalted nuts and a tangerine before bedtime, his number was 140, also very good after all that sugar. Do you think he is appropriate for an insulin pump? I was told that he could go into Insulin Coma with his low blood sugar numbers within 3 hours and need to watch him closely. I have been his caregiver since 2003 and try my hardest to follow all the instructions and read about everything in medical magazines about Diabetes 2, but never saw anything about Brittle Diabetes or Insulin Coma. Can you offer me any advice on what needs to be done next, since it is very scary when he starts sweating.
Thanks very much. I look forward to your reply promptly. Happy Holiday.
Sincerely,
Phyllis Mehlman

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The contents displayed within this public group(s), such as text, graphics, and other material ("Content") are intended for educational purposes only. The Content is not intended to substitute for professional medical advice, diagnosis, or treatment. . . .